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Melissa L. P. Mattison, MD; Kevin A. Afonso, BSBA; Long H. Ngo, PhD; Kenneth J. Mukamal, MD

Arch Intern Med. 2010;170(15):1331-1336. doi:10.1001/archinternmed.2010.244

Background  Potentially inappropriate medication (PIM) use in hospitalized older patients is common. Our objective was to determine whether a computerized provider order entry (CPOE) drug warning system can decrease orders for PIMs in hospitalized older patients.

Methods  We used a prospective before-and-after design among patients 65 years or older admitted to a large, urban academic medical center in Boston, Massachusetts, from June 1, 2004, through November 29, 2004 (for patients admitted before the warning system was added), and from March 17, 2005, through August 30, 2008 (patients admitted after the warning system was added). We instituted a medication-specific warning system within CPOE that alerted ordering providers at the point of care when ordering a PIM and that advised alternative medication or dose reduction. The main outcome measure was the rate of orders for PIMs before and after the warning system was deployed.

Results  The mean (SE) rate of ordering medications that were not recommended dropped from 11.56 (0.36) to 9.94 (0.12) orders per day after the implementation of a CPOE warning system (difference, 1.62 [0.33]; P < .001), with no evidence that the effect waned over time. There were no appreciable changes in the rate of ordering medications for which only dose reduction was recommended or that were not targeted after CPOE implementation. These effects persisted in autoregressive models that accounted for secular trends and season (P < .001).

Conclusion  Specific alerts embedded into a CPOE system, used in patients 65 years or older, can decrease the number of orders of PIMs quickly and specifically.

Author Affiliations: Divisions of Gerontology (Dr Mattison) and General Medicine and Primary Care (Drs Mattison, Ngo, and Mukamal), Department of Medicine, and Department of Clinical Systems Development (Mr Afonso), Beth Israel Deaconess Medical Center, Boston, Massachusetts.

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